Dear Patient:

 Your fees are based on the time I spend with you during your visit, the complexity of your medical condition and any treatment I provide. But Proper attention to your care also requires that I-or members of my staff-spend additional time beyond that which we spend with you in the office. Such times may be used to:

 �        Create or maintain your permanent medical record.

 �        Review current X-ray or scan reports, compare them with reports of previous scans, and when the studies are abnormal, consult a radiologist.

 �        Review, interpret, and document all labs test results and communicate those results-orally or in writing-to you.

 �        Prepare and mail consultation reports and letters suggesting patients coming in for a follow up visit.

 �        Consult via phone about your case with referring or consulting physicians and other health care providers.

 �        Prepare referral letters to additional specialist, as needed.

 �        Prepare patient educational materials.

 �        Conduct medical research relevant to your case.

 �        Communicate with pharmacies about your prescriptions.

 �        Complete insurance application and claim forms.

 �        Conduct utilization review negotiations with hospital and insurance companies.

 �        Review and manage hospital records .Draft letters of necessity to obtain medical services, instruments, or prescriptions that you need.

 �        Arrange for hospital admissions and follow up consultations with nurses, attending physicians, and house staff.

�        Draft reports and forms including home health care orders and nursing facility orders.

 All these activities add to our cost of doing business. Still we are committed to providing you the best possible care at the lowest cost. We hope this explanation of our fees has been helpful. With you, our patient, we look forward to a lasting and healthy relationship. 

Sincerely,

Karen L. Smith MD Physician/Owner